Outcomes of emergency endovascular versus open repair for abdominal aortic aneurysm rupture

Abstract

Purpose Ruptured abdominal aortic aneurysm (rAAA) is one of the most common aortic emergencies in vascular surgery and is associated with high operative mortality and morbidity rates despite recent treatment advances. We evaluated operative mortality risks for the outcomes of emergency endovascular aneurysm repair (eEVAR) vs. open repair in rAAA. Methods Twenty patients underwent eEVAR (n = 12) or open repair (n = 8) for rAAA between 2016 and 2020. We adopted the EVAR first strategy since 2018. Primary endpoints included in-hospital mortality and 1-year survival. The outcome variables were analyzed with Fisher exact, Mann-Whitney test, and linear by linear association. The Kaplan-Meier method was used to estimate survival. Results There were 13 males (65.0%) and the median age of the study cohort was 78.0 years (range, 49–88 years). In-hospital mortality occurred in 7 patients (35.0%); 5 (50.0%) in the early period and 2 (20.0%) in the later period of this series. According to the procedure type, 4 (50.0%) and 3 (25.0%) in-hospital mortalities occurred in the open repair and eEVAR patients, respectively. In 6 patients (50.0%), eEVAR was performed on unfavorable anatomy. The 1-year survival of eEVAR vs. open repair group was 75% ± 12.5% and 50% ± 17.7%, respectively. On univariate analysis, preoperative high-risk indices, postoperative acute renal failure requiring dialysis, pulmonary complications, and prolonged mechanical ventilation were associated with higher operative mortality. Conclusion The current data showed relatively superior outcomes with eEVAR vs. open repair for rAAA, even in some patients with unfavorable anatomy supporting the feasibility, efficacy, and safety of EVAR first strategy.

Anatomical feasibility of fenestrated stent graft to treat complex abdominal aortic aneurysms from a Korean single institute database

“…In contrast, premade devices including p-Branch, which was developed to cover AAAs originating below SMA and reinforce the sealing zone to avoid stent fracture and endoleak, are applicable in emergency cases [ 16 ]. For example, in ruptured AAA patients, only premade devices can be used to perform EVAR, and recent studies comparing emergency EVAR and open surgery repair reported that emergency EVAR tended to exhibit lower mortality [ 17 18 ]. Both premade devices and custom-made devices are inapplicable in cases of severe neck angulation.…”

Single centre experience with Excluder® stent graft; 17-year outcome

“…Emergency EVAR was performed in cases of anatomically suitable AAA rupture and in hemodynamically stable patients. 16 The decision in these cases was left to the interventional radiologist on duty.…”